Anemia as a risk factor for all-cause mortality: Obscure synergic effect of chronic kidney disease

Yuji Sato, Shouichi Fujimoto, Tsuneo Konta, Kunitoshi Iseki, Toshiki Moriyama, Kunihiro Yamagata, Kazuhiko Tsuruya, Ichiei Narita, Masahide Kondo, Masato Kasahara, Yugo Shibagaki, Koichi Asahi, Tsuyoshi Watanabe

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Abstract

Background Anemia is common in chronic kidney disease (CKD) and may be associated with mortality in CKD patients. However, few studies have examined this relationship in Asian populations. Methods A total of 62,931 Japanese people (age 64.0 ± 8.0 years; men 38.5%) were followed up from 2008 to 2012. Participants were divided into six groups in accordance with their estimated glomerular filtration rate (eGFR) (<45, 45-59, ≥60 mL/min/1.73 m 2 ) and by hemoglobin levels (13.0 g/dL for men; 12.0 g/dL for women). Hazard ratio and confidence interval (CI) for mortality with a combination of eGFR and anemia were calculated. After matching using propensity score (PS) for anemia, survival analysis between anemic and non-anemic people, independent from some variables, including eGFR, was performed. Results A total of 828 (1.3%) participants died (non-anemic vs. anemic, 1.2 vs. 2.3%, p < 0.01). Multivariable Cox analysis showed that, independent of eGFR levels, anemic people had significantly higher mortality. Anemic people were found to have significantly poorer survival than non-anemic people as per a log-rank test (p < 0.01) for the PS-matching cohort. Further stratified logistic analysis using PS in the overall cohort odds ratio (95% CI) showed 2.25 (1.89-2.67) with p < 0.01. Conclusion The results of the present study showed that anemia was an independent risk factor of all-cause mortality.

Original languageEnglish
Pages (from-to)388-394
Number of pages7
JournalClinical and Experimental Nephrology
Volume22
Issue number2
DOIs
Publication statusPublished - Jan 1 2018

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Glomerular Filtration Rate
Chronic Renal Insufficiency
Propensity Score
Anemia
Mortality
Confidence Intervals
Survival Analysis
Hemoglobins
Odds Ratio
Survival
Population

All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

Cite this

Sato, Y., Fujimoto, S., Konta, T., Iseki, K., Moriyama, T., Yamagata, K., ... Watanabe, T. (2018). Anemia as a risk factor for all-cause mortality: Obscure synergic effect of chronic kidney disease. Clinical and Experimental Nephrology, 22(2), 388-394. https://doi.org/10.1007/s10157-017-1468-8

Anemia as a risk factor for all-cause mortality : Obscure synergic effect of chronic kidney disease. / Sato, Yuji; Fujimoto, Shouichi; Konta, Tsuneo; Iseki, Kunitoshi; Moriyama, Toshiki; Yamagata, Kunihiro; Tsuruya, Kazuhiko; Narita, Ichiei; Kondo, Masahide; Kasahara, Masato; Shibagaki, Yugo; Asahi, Koichi; Watanabe, Tsuyoshi.

In: Clinical and Experimental Nephrology, Vol. 22, No. 2, 01.01.2018, p. 388-394.

Research output: Contribution to journalArticle

Sato, Y, Fujimoto, S, Konta, T, Iseki, K, Moriyama, T, Yamagata, K, Tsuruya, K, Narita, I, Kondo, M, Kasahara, M, Shibagaki, Y, Asahi, K & Watanabe, T 2018, 'Anemia as a risk factor for all-cause mortality: Obscure synergic effect of chronic kidney disease', Clinical and Experimental Nephrology, vol. 22, no. 2, pp. 388-394. https://doi.org/10.1007/s10157-017-1468-8
Sato, Yuji ; Fujimoto, Shouichi ; Konta, Tsuneo ; Iseki, Kunitoshi ; Moriyama, Toshiki ; Yamagata, Kunihiro ; Tsuruya, Kazuhiko ; Narita, Ichiei ; Kondo, Masahide ; Kasahara, Masato ; Shibagaki, Yugo ; Asahi, Koichi ; Watanabe, Tsuyoshi. / Anemia as a risk factor for all-cause mortality : Obscure synergic effect of chronic kidney disease. In: Clinical and Experimental Nephrology. 2018 ; Vol. 22, No. 2. pp. 388-394.
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abstract = "Background Anemia is common in chronic kidney disease (CKD) and may be associated with mortality in CKD patients. However, few studies have examined this relationship in Asian populations. Methods A total of 62,931 Japanese people (age 64.0 ± 8.0 years; men 38.5{\%}) were followed up from 2008 to 2012. Participants were divided into six groups in accordance with their estimated glomerular filtration rate (eGFR) (<45, 45-59, ≥60 mL/min/1.73 m 2 ) and by hemoglobin levels (13.0 g/dL for men; 12.0 g/dL for women). Hazard ratio and confidence interval (CI) for mortality with a combination of eGFR and anemia were calculated. After matching using propensity score (PS) for anemia, survival analysis between anemic and non-anemic people, independent from some variables, including eGFR, was performed. Results A total of 828 (1.3{\%}) participants died (non-anemic vs. anemic, 1.2 vs. 2.3{\%}, p < 0.01). Multivariable Cox analysis showed that, independent of eGFR levels, anemic people had significantly higher mortality. Anemic people were found to have significantly poorer survival than non-anemic people as per a log-rank test (p < 0.01) for the PS-matching cohort. Further stratified logistic analysis using PS in the overall cohort odds ratio (95{\%} CI) showed 2.25 (1.89-2.67) with p < 0.01. Conclusion The results of the present study showed that anemia was an independent risk factor of all-cause mortality.",
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T1 - Anemia as a risk factor for all-cause mortality

T2 - Obscure synergic effect of chronic kidney disease

AU - Sato, Yuji

AU - Fujimoto, Shouichi

AU - Konta, Tsuneo

AU - Iseki, Kunitoshi

AU - Moriyama, Toshiki

AU - Yamagata, Kunihiro

AU - Tsuruya, Kazuhiko

AU - Narita, Ichiei

AU - Kondo, Masahide

AU - Kasahara, Masato

AU - Shibagaki, Yugo

AU - Asahi, Koichi

AU - Watanabe, Tsuyoshi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background Anemia is common in chronic kidney disease (CKD) and may be associated with mortality in CKD patients. However, few studies have examined this relationship in Asian populations. Methods A total of 62,931 Japanese people (age 64.0 ± 8.0 years; men 38.5%) were followed up from 2008 to 2012. Participants were divided into six groups in accordance with their estimated glomerular filtration rate (eGFR) (<45, 45-59, ≥60 mL/min/1.73 m 2 ) and by hemoglobin levels (13.0 g/dL for men; 12.0 g/dL for women). Hazard ratio and confidence interval (CI) for mortality with a combination of eGFR and anemia were calculated. After matching using propensity score (PS) for anemia, survival analysis between anemic and non-anemic people, independent from some variables, including eGFR, was performed. Results A total of 828 (1.3%) participants died (non-anemic vs. anemic, 1.2 vs. 2.3%, p < 0.01). Multivariable Cox analysis showed that, independent of eGFR levels, anemic people had significantly higher mortality. Anemic people were found to have significantly poorer survival than non-anemic people as per a log-rank test (p < 0.01) for the PS-matching cohort. Further stratified logistic analysis using PS in the overall cohort odds ratio (95% CI) showed 2.25 (1.89-2.67) with p < 0.01. Conclusion The results of the present study showed that anemia was an independent risk factor of all-cause mortality.

AB - Background Anemia is common in chronic kidney disease (CKD) and may be associated with mortality in CKD patients. However, few studies have examined this relationship in Asian populations. Methods A total of 62,931 Japanese people (age 64.0 ± 8.0 years; men 38.5%) were followed up from 2008 to 2012. Participants were divided into six groups in accordance with their estimated glomerular filtration rate (eGFR) (<45, 45-59, ≥60 mL/min/1.73 m 2 ) and by hemoglobin levels (13.0 g/dL for men; 12.0 g/dL for women). Hazard ratio and confidence interval (CI) for mortality with a combination of eGFR and anemia were calculated. After matching using propensity score (PS) for anemia, survival analysis between anemic and non-anemic people, independent from some variables, including eGFR, was performed. Results A total of 828 (1.3%) participants died (non-anemic vs. anemic, 1.2 vs. 2.3%, p < 0.01). Multivariable Cox analysis showed that, independent of eGFR levels, anemic people had significantly higher mortality. Anemic people were found to have significantly poorer survival than non-anemic people as per a log-rank test (p < 0.01) for the PS-matching cohort. Further stratified logistic analysis using PS in the overall cohort odds ratio (95% CI) showed 2.25 (1.89-2.67) with p < 0.01. Conclusion The results of the present study showed that anemia was an independent risk factor of all-cause mortality.

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